Provider Demographics
NPI:1902967672
Name:VELLA, CHARLES J (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:VELLA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 GEARY BLVD
Mailing Address - Street 2:KAISER, DEPT. PSYCHIATRY
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-3109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:415-833-4765
Practice Address - Street 1:4141 GEARY BLVD
Practice Address - Street 2:KAISER HOSPITAL
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-3109
Practice Address - Country:US
Practice Address - Phone:415-833-3146
Practice Address - Fax:415-833-4765
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 5464103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist